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2019, Number 3

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Revista Habanera de Ciencias Médicas 2019; 18 (3)

Validation of a prognostic model of death in malnourished children admitted to intensive care units

Álvarez AME, Sánchez PLM, Rubén QM, Méndez PS, Cuevas ÁD
Full text How to cite this article

Language: Spanish
References: 40
Page: 388-402
PDF size: 659.21 Kb.


Key words:

pediatrics, malnutrition, intensive care, prediction, mortality, obtaining of variables.

ABSTRACT

Introduction: Malnutrition associated with severe disease represents an important factor that increases mortality in pediatric patients.
Objective: To validate a prognostic model of death in malnourished children admitted to intensive care units.
Material and Methods: An observational cohort study was carried out in patients with acute malnutrition, admitted to three Intensive Care Units of Pediatric Hospitals in Havana, out of which "Angel Arturo Aballí" Mother-Child Teaching Hospital served as the research center. The work was carried out from January 2011 to May 2018. A total of 234 cases were evaluated. Discrimination and calibration of a prognostic model of death was determined.
Results: As general characteristics, there was a greater number of patients among the infants under 7 months of age. The main causes of admission were digestive and respiratory infections and sepsis, this last one had a significant relationship with the probability of death. Likewise, there was a significant association between the longer lengths of stay and death. The validated model showed an excellent discrimination with value of the area under the curve of 0.99 and good calibration with p = 0 .289.
Conclusions: The prognostic model of death applied to malnourished children admitted to intensive care units showed a satisfactory performance to be applied in this patient population and has, as an additional characteristic, an easy clinical application given the feasibility of obtaining the variables that constitute it.


REFERENCES

  1. Burgos Peláez R. Desnutrición y enfermedad. Nutr Hosp. [Internet]. 2013; Supl 6(1):10-23. [Consultado 12 Septiembre 2018]. Disponible en: http://www.redalyc.org/articulo.oa?id= 309228933002

  2. Velandia S, Hodgson MI, Le Roy C. Evaluación nutricional en niños hospitalizados en un servicio de pediatría. Rev Chil Pediatr [Internet]. 2016; 87(5):331-438. [Consultado 12 Septiembre 2018]. Disponible en: http://Doi.org/10.1016/j.rchipe. 2016.05.001.

  3. Freijer K, Wijnkoop L, Russell C, Koopmanschap M, Kruizenga H, Lhachimi S, et al. The view of European experts regarding health economics for medical nutrition in diseaserelated mal¬nutrition. Eur J Clin Nutr [Internet]. 2015;69:539-45. [Cited 12 septiembre 2018]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/256047

  4. Vaquerizo Alonso C. Nutrición parenteral en el paciente crítico: indicaciones y controversias. Nutr Clin Med. [Internet]. 2017; 21(1):26-41. [Consultado 7 Agosto 2018]. Disponible en: http://www.aulamedica.es/nutricionclinicamedi cina/pdf/5048.pdf

  5. Martínez Gómez JA. Relación entre la morbimortalidad, estado fisiológico y estado nutricional de pacientes de la unidad de terapia intensiva pediátrica. Tesis en Maestría en Ciencias Médicas. Universidad de San Carlos de Guatemala. 2015. San Carlos. Guatemala. [Internet]. 2017. [Consultado 4 de Septiembre 2018]. Disponible en: http://www.repositorio.usac.edu.gt/id/eprint/7 140

  6. Goldstein B, Giroir B, Randolph A. International Pediatric Sepsis Consensus Conference: Definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. [Internet]. 2005; 6(2): 2-8. [Cited 4 de Septiembre 2018]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/156366 51

  7. Álvarez Andrade ME, Esquivel Lauzurique M, Rubén Quesada M. Factores pronósticos de muerte en niños portadores de desnutrición aguda ingresados en cuidados intensivos. Rev haban Cien Méd [Internet]. 2015;14(5): 573-586. [Consultado 4 de Septiembre 2018]. Disponible en: http:// www.revhabanera.sld.cu/index.php/rhab/article /view/982

  8. Cerda J, Cifuentes L. Uso de curvas ROC en investigación clínica. Aspectos teórico-prácticos. Rev Chil Infect [Internet]. 2012] ; 29(2):138-141. [Consultado 7 Agosto 2018]. Disponible en: http://dx.doi.org/10.4067/S0716- 10182012000200003

  9. Lemeshow S, Hosmer DW. A review of goodness of fit statistics for use in the development of logistic regression models. American Journal of Epidemiology. [Internet]. 1982; 115:92-106. [Cited 7 Agosto 2018]. Available from: https://Doi.org/10.1093/oxfordjournals.aje.a113 284

  10. Metha NM, Duggan CP. Nutritional deficiencies during critical illness. Pediatr Clin North Am. [Internet]. 2009; 56(5):1143-60. [Cited 7 Agosto 2018]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PM C4641569/

  11. Zwart H,Hop WC, Hulst JM.).National malnutrition screening days in hospitalized children in The Netherlands. Arch Dis Child [Internet]. May 2010; 95: 141-145. [Cited 4 de Septiembre 2018]. Available from: http://Doi:10.1136/adc.2008.157255

  12. Cordero Herrera AM. Principales enfermedades asociadas al estado nutricional en el niño menor de un año. Medicent Electrón. Villa Clara [Internet]. 2014; 18(3):100-106. [Consultado 12 Septiembre 2018]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext &pid=S1029-30432014000300003

  13. Qiu J, Lu X, Wang K, Zhu Y, Zuo Ch, Xiao Z, Comparison of the pediatric risk of mortality, pediatric index of mortality, and pediatric index of mortality 2 models in a pediatric intensive care unit in China. Medicine (Baltimore) [Internet]. 2017 Apr; 96(14): e6431. [Cited 22 Julio de 2018]. Available from: http://Doi:10.1097/MD.0000000000006431

  14. Singhai D, Kumar N, Puliyel JM, Singh-Bellad R, Rao S, Patil VD, Mahantshetti NS. Outcome of Intensive Care Unit Patients using Pediatric Risk of Mortality Score (PRISM). Indian Pediatr. [Internet]. 2009; 46:1091-92. [Cited 12 Julio de 2018]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/194300 67

  15. Segurola Gurrutxaga H, Cárdenas Lagranja G, Burgos Peláez R. Nutrientes e inmunidad. Nutr Clin Med. [Internet]. 2016; X(1):1-19. [Consultado 12 Septiembre 2018]. Disponible en: http://Doi:10.7400/NCM.2016.10.1.5034

  16. De Poi, F. Incidencia del estado nutricional en distintos grados de infección. Tesis Licenciatura en Nutrición. Universidad FASTA, Fraternidad de Agrupaciones Santo Tomas de Aquino. Mar del Plata, Buenos Aires. Argentina [Internet]. 2013. [Consultado 12 Septiembre 2018]. Disponible en: http://redi.ufasta.edu.ar:8080/xmlui/handle/12 3456789/298.

  17. Campos-Miño S, Sasbón JS, Von Dessauer B. Los cuidados intensivos pediátricos en Latinoamérica. Med Intensiva. [Internet]. 2012; 36(1):3-10. [Consultado 22 Julio de 2018]. Disponible en: http://scielo.isciii.es/pdf/medinte/v36n1/origina l1.pdf.

  18. Moschovis PP, Addo-Yobo EO, Banajeh S, Chisaka N, Christiani DC, Hayden D, et al. Stunting is associated with poor outcomes in childhood pneumonia. Trop Med Int Health. [Internet]. 2015 Oct; 20(10):1320-28. [Cited 12 Septiembre 2018]. Available from: http://Doi:10.1111/tmi.12557.

  19. Singer M, Deutschman C, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock. JAMA.[Internet]. 2016 Feb; 315(8):801-10. [Cited 22 Julio de 2018]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC 4968574

  20. Liu V, Escobar GJ, Greene JD. Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA. [Internet]. 2014; 312(1):90-92. [Cited 22 Julio de 2018]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/248383 55

  21. Baique-Sánchez PM. Sepsis en pediatría: nuevos conceptos. An Fac Med. [Internet]. 2017;78(3):333-342. [Consultado 22 Julio de 2018]. Disponible en: http://doi.org/10.15381/anales.v78i3.13769

  22. Howell MD, Davis AM. Management of Sepsis and Septic Shock. JAMA [Internet]. February 2017; 317(8). [Cited 12 Septiembre 2018]. Available from: http://doi:10.1001/jama.2017.0131.

  23. Matics TJ, Sanchez-Pinto LN. Adaptation and Validation of a Pediatric Sequential Organ Failure Assessment Score and Evaluation of the Sepsis-3 Definitions in Critically Ill Children. JAMA Pediatr [Internet]. 2017; 171(10). [Cited 12 septiembre 2018]. Available from: http://:Doi:10.1001/jamapediatrics.2017.2352

  24. Pantoja-Chamorro F, Mazzillo-Vega L, Palacios-Barahona U. Análisis de la asociación entre procalcitonina y mortalidad por sepsis en menores de 18 años en una unidad de cuidados intensivos, Pasto- Colombia 2012 - 2014. Rev Univ Salud. [Internet]. 2018; 20(1):64-71. [Consultado 12 Septiembre 2018]. Disponible en: http://dx.doi.org/10.22267/rus.182001.110

  25. Salcedo Reyes C, Villarreal Pérez PR, Agramonte Valle N. Sepsis severa y shock séptico en la Unidad de Cuidados Intensivos. Pediátrico de Sancti Spiritus. Gaceta Médica Espirituana. [Internet]. 2015; 17(1). [Consultado 22 Julio de 2018]. Disponible en: http://scielo.sld.cu/pdf/gme/v17n1/GME03115. pdf

  26. Secker DJ, Jeejeebhoy KN. How to perform Subjective Global Nutritional assessment in children. J Acad Nutr Diet [Internet]. 2012; 112(3):424–431. [Cited 22 Julio de 2018]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/227172 02

  27. Joosten KF, Zwart H, Hop WC, Hulst JM. National malnutrition screening days in hospitalized children. Arch Dis Child. [Internet]. May 2010; 95:141-145. [Cited 4 de Mayo 2018]. Available from: http://Doi:10.1136/adc.2008.157255

  28. Ulibarri Pérez JI, Lobo Támer G, Pérez de la Cruz AJ Desnutrición clínica y riesgo nutricional en 2015. Nutr Clin Med. [Internet]. 2015; 9(3):231-254. [Consultado 22 Julio de 2018]. Disponible en: http://Doi:10.7400/NCM.2015.09.3.5033

  29. Araújo Costa G, Delgado AF, Ferraro A, Suely Okay T. Application of the Pediatric Risk of Mortality Score (PRISM) score and determination of mortality risk factors in a tertiary pediatric intensive care unit. Brasil. Clinics (Sao Paulo) [Internet]. Nov 2010;65(11):1087–92. [Cited 12 Septiembre 2018]. Available from: http://Doi:10.1590/S1807-59322010001 100005

  30. Pollack MM, Holubkov R, Funai T, Dean JM, Berger JT, Wessel DL, et al The Pediatric Risk of Mortality Score: Update 2015. Pediatr Crit Care Med. [Internet]. 2016 Jan;17(1):2-9. [Cited 4 de Mayo 2018]. Available from: http://Doi:10.1097/PCC.0000000000000558.

  31. Vázquez A, Herrera-Pérez E, Tantaleán J, Escalante-Kanashiro R. PRISM como predictor de mortalidad en la unidad de cuidados intensivos pediátricos del Instituto Nacional de Salud del Niño, Perú 2012. Acta Med Perú. [Internet]. 2016; 33(1):9-14. [Consultado 4 de Mayo 2018]. Disponible en: http://www.scielo.org.pe/scielo.php?script=scia rttext&pid=S1728-5917201600 0100003

  32. Taori RN, Lahiri KR, Tullu MS. Performance of PRISM (Pediatric Risk of Mortality) Score and PIM (Pediatric Index of Mortality) Score in a Tertiary Care Pediatric ICU. Indian J Pediatr [Internet]. 2010; 77 (3):267-271. [Cited 4 de Mayo 2018]. Available from: http://Doi:doi:10.1007/s12098- 010-0031-3

  33. Vinayak KP, Sandeep R, Jennifer VA. Comparison of Severity Scoring Systems in a Pediatric Intensive Care Unit in India: A Single- Center Prospective, Observational Cohort Study. J Pediatr Intensive Care. [Internet]. 2017; 6(2): 98-102. [Cited 3 de Marzo 2018]. Available from: http://Doi:10.1055/s-0036-1584811

  34. Canonero I, Figueroa A, Cacciamano A, Olivier E, Cuestas E. Validation of PRISM and PIM2 scores of mortality in a pediatric intensive care unit in Cordoba. Arch Argent Pediatr. [Internet]. 2010; 108:427–33. [Cited 3 de Marzo 2018]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/211322 31.

  35. Espuñes SP, Cid JL, Galán CR, Villanueva AM, Torre AC, Camblor P. Índices pronósticos de mortalidad en cuidados intensivos pediátricos. An Pediatr (Barc). [Internet]. 2007;66:345-50. [Consultado 22 Julio de 2018]. Disponible en: http://Doi:10.1157/13101237.

  36. Slater A, Shann F. The suitability of the pediatric index of mortality (PIM), PIM2, the pediatric risk of mortality (PRISM), and PRISM III for monitoring the quality of pediatric intensive care in Australia and New Zealand. Pediatr Crit Care Med. [Internet]. 2004; 5:447-54. [Consultado 3 de Marzo 2018]. Available from: http://Doi:10.1097/01.PCC.0000138557.31831.6 5.

  37. Thukral A, Lodha R, Irshad M, Arora NK. Performance of pediatric risk of mortality (PRISM), pediatric index of mortality (PIM), and PIM2 in a pediatric intensive care unit in a developing country. Pediatr Crit Care Med [Internet]. 2006; 7:356-61. [Cited 22 Julio de 2018]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/167385 02.

  38. Qureshi AU, Ali AS, Ahmad TM. Comparison of three prognostic scores (PRISM, PELOD and PIM 2) at pediatric intensive care unit under Pakistani circumstances. J Ayub Med Coll Abbottabad. [Internet]. 2007;19:49–53. [Cited 22 Julio de 2018]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/181837 20.

  39. Wells M, Riera-Fanego JF, Luyt DK, Dance M, Lipman J. Poor discriminatory performance of the Pediatric Risk of Mortality(PRISM) score in a South African intensive care unit. Crit Care Med. [Internet]. 1996; 24(9):1507-13. [Cited 4 de Mayo 2018]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/879762 3

  40. Vázquez Carranza I, Vargas Astrada A, Garduño Rebollo MV. Estado nutricional como factor de riesgo de mortalidad en el paciente críticamente enfermo, hospitalizado por proceso infeccioso. Rev Arch Inv Marterna Infantil. México.[Internet].2009; 1(2):55-7. [Consultado 22 Julio de 2018]. Disponible en: http://www.medigraphic.com/pdfs/imi/imi- 2009/imi092c.pdf




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